Health Insurance Policies

Health Insurance gives you coverage if you need medical care or are in the hospital. Your insurance policy explains in writing what is and what is not covered. Consumers can buy health insurance policies as either "Group" or "Individual/Family" policies.

Group Policies are purchased by your employer or an association (such as AARP). The policy is issued in the name of the group and Certificates of Coverage are issued to the group members (employees). You may be able to add family members or dependents on your policy and your employer may require you to pay for some or all of the monthly premium.

An Individual/Family Policy is insurance you buy outside of an employer or association. The policy is issued to the individual who applies for it and their family. Once you have an individual/family policy, you can add other family members and dependents in some cases.

Insurance is subject to the laws in the State where the policy is issued. In California, insurance is regulated by the California Department of Insurance.

Covered California: California's Healthcare Marketplace

As part of the Affordable Care Act, California created a health insurance marketplace called Covered California. Through Covered California, individuals, families, and small businesses can purchase insurance products sold by private insurers. Covered California also helps individuals and families determine if they qualify for the Medi-Cal program and subsidies from the federal government toward purchase of a private insurance plan. Visit Covered California for more information about getting coverage.

Should I get a private or a marketplace plans?

Private insurance plans are those you can buy directly from an insurance company. Depending on your state, private insurance plans may differ from marketplace insurance plans in various ways.

Marketplace insurance refers to insurance plans available on the federal or state health insurance marketplace.  As part of the Affordable Care Act, California created a health insurance marketplace called Covered California. 

Through Covered California, individuals, families, and small businesses can purchase insurance products sold by private insurers. Covered California also helps individuals and families determine if they qualify for the Medi-Cal program and subsidies from the federal government toward purchase of a private insurance plan. Visit Covered California for more information about getting coverage.

Shopping for Individual/Family Coverage

You can buy health insurance in the individual/family market if you do not get health insurance through your employer and you do not qualify for Medi-Cal or another public program.

Before the Affordable Care Act (ACA), consumers faced many problems in the individual/family market. Now, with the ACA, consumers have more protections. Some of these are:

• Insurers can no longer deny you coverage if you have a 'pre-existing condition'

• Insurers can no longer charge you more based on your health status;

• The Federal government offers subsidies to lower the cost of your premium if you meet certain income criteria.

For example, a family of four making up to about $94,000 per year may qualify for a subsidy to offset their monthly premium cost.

If you qualify for a subsidy, you have to purchase your coverage through Covered California to take advantage of it.

Shopping for Small Business Coverage

Covered California for Small Business has health insurance companies that are available for year-round enrollment in the small-business program. Because employees have the opportunity to compare and select health plans at a variety of price points, the result is greater choice and coverage that is more closely tailored to individual needs.  Health insurance options and pricing vary by region and are based on the employer’s principal business location.

What are the health plan options?

Covered California for Small Business offers four levels of coverage — Bronze, Silver, Gold and Platinum — each with multiple plan options. We make it easy for you to choose not one level, but two adjoining levels of coverage. You pick. Your employees have the option to select any plan within those two levels. For example, you can control your budget by selecting a Silver plan as your reference plan while allowing employees to move up to Gold. This provides your employees with a choice of multiple health plan options from Health Insurance Through Covered California companies, allowing them to find one that fits their needs and budget.

Creditable Coverage

Employers must provide an annual written disclosure notice to each Medicare-eligible employee as to whether their prescription drug coverage is creditable, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. Accordingly, this information is essential to an individual’s decision whether to enroll in a Medicare Part D prescription drug plan.